| NPI | 1629301031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL 54241) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 5396) |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2025-09-28 |